Thank you for helping to create a unique learning opportunity for a local student! In order to best match your company with an intern, please complete the following information to be shared with students as part of the selection process. Please complete a separate form for each different internship position you are offering.

* Required

Intern Host/Mentor Name *

Your answer

Intern Host/Mentor Email *

Your answer

Company Name (No abbreviations please) *

Your answer

Address, City, State, ZIP Code

Your answer

Phone Number

Your answer

Industry Type (e.g., Energy, Social Services, etc.)

Your answer

If you can take multiple interns for one position, please note how many